Provider Demographics
NPI:1659371979
Name:OWCZARZAK, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:OWCZARZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1042
Mailing Address - Country:US
Mailing Address - Phone:810-733-3660
Mailing Address - Fax:810-720-4777
Practice Address - Street 1:5142 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1042
Practice Address - Country:US
Practice Address - Phone:810-733-3660
Practice Address - Fax:810-720-4777
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4536958Medicaid
MI0N74950002Medicare ID - Type Unspecified
MIH07912Medicare UPIN